Can I use Polydioxanone (PDS) suture for a perineal laceration repair?

From the Guidelines

You should not use Polydioxanone (PDS) suture as the first choice for a perineal laceration repair due to its longer absorption time and potential for increased tissue reaction. The most recent and highest quality study, published in 2024 in the American Journal of Obstetrics and Gynecology 1, suggests that standard synthetic sutures, such as multifilament polyglycolic acid or polyglactin 910, and monofilament poliglecaprone or polyglyconate, are preferred for perineal laceration repairs. Some key points to consider when choosing a suture material for perineal laceration repair include:

• The risk of pain and the need for resuturing associated with different suture types
• The potential for bacterial seeding and infection with multifilament sutures
• The importance of proper wound care and follow-up, regardless of the suture material used
• The benefits of using monofilament sutures, which may be less likely to cause infection and are preferred due to less bacterial seeding 1. In general, faster-absorbing sutures like Vicryl (polyglactin 910) or Monocryl (poliglecaprone 25) are more suitable for perineal tissue healing due to their shorter absorption times and lower risk of tissue reaction. If PDS is used, it would be more suitable for the deeper layers of a more severe laceration, while using a faster-absorbing suture for the superficial layers. It's essential to weigh the benefits and drawbacks of each suture material and consider the individual patient's needs and circumstances when making a decision.

From the Research

Suture Materials for Perineal Laceration Repair

• The provided studies do not specifically mention the use of Polydioxanone (PDS) suture for perineal laceration repair 2, 3, 4, 5, 6.
• However, the studies compare different suture materials and techniques for perineal repair, including polyglycolic acid, chromic catgut, and silk 4.
• One study found that polyglycolic acid required less short-term analgesia and reduced the need for resuturing compared to chromic catgut 4.
• Another study compared nonsuturing or skin adhesives versus suturing of the perineal skin and found that nonsuturing or skin adhesives led to less short-term and long-term pain 3.

Alternative Methods for Perineal Laceration Repair

• Some studies investigated the use of non-surgical glue or surgical adhesive glue as an alternative to sutures for repairing perineal lacerations 5, 6.
• These studies found that non-surgical glue or surgical adhesive glue was associated with less pain, faster repair, and greater satisfaction compared to sutures 5, 6.
• However, the use of Polydioxanone (PDS) suture was not evaluated in these studies.

Suturing Techniques for Perineal Laceration Repair

• One study compared three suturing techniques (continuous, interrupted cutaneous, and interrupted subcutaneous) for perineal repair and found no statistically significant differences between the groups in terms of perineal pain and healing 2.
• Another study compared continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin and found no clear difference between the two techniques 4.